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F= t7' - `" 1 ✓ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION-................. ------------------------------------------------------------ Owner's Name---------------------------------------------------Chas---Winans------------------------------------------------------------------- Phone--- 4 81-------------- Address--------------------- ---------•---------------•----2.3-27---Fnst-on_AY-e.._.-.-.S Qckt—on--------------------------------------------------------------- Contractor's Name--------- ----T-NC------------•----------------a------------------ ------ Phone-----9.!!!-96Q7------------- Installation will serve: Residence XI: Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 2 Number of baths Q Lot size----- Q1----x---1QDt------------------------------ K5 Water Supply: Public system Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobeu Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation___-_-_.----______-Material--_-___-_----_____---_----------_-----.--------_- OP3MJD?Rg No. of compartments-------------------------Capacity---------------------Size-------------------------------Liquid depth-------------------------- W EN Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.___- -_-"--_-____--------__- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ 1-1 Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well------HQile-----Dista -Trom-4ound ion-_-4Q.!--------Distance to nearest lot line--- I xx Number of pits------------ -------Lining m eria-----_______"BY'___-Si Diameter---33�t Depth----2" t_--_--___"""----__-,- wDispasal Field: Distance from nearest well_________________Distanc ndation--------------------Distance to nearest lot line_-___""---"----_t Number of lines---------------------------- Length of each line____----------"_--"" Exf�tiri�, ----Len ----------Width of trench----------------------- ---------- - - Type of filter material-------------------------Depth of filter material--"_"------------------ Remodeling and/or repairing (describe):--------Supplement---to---existing---drainage---s-Y"S-t-em-o------------------------------ -------------------------•------ --------------------------------------------------------------------------------------------------------------------------------------------------------• ---------------------------- ' ".� -----------------------"-------•---------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned D. A P RRI SONS.. INC. -------------' •-- ------------- (�Contractor) ( s ] ------------ -t-i- --------- BY� Z - --------------------------------------------------------------------------------(Title)----Estimator-------------------------------- (Plot plans, showin size of lot, location f system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --------------------------------------- DATE------ REVIEWED BY -------- DATE -------, ------------------------------- ------------- BUILDINGPERMIT ISSUED-------------------------------------------------------- -----------------,--------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------ ---•--------------------------------------------------' -------------------------------------•-----------------------------------------'-------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------'--------------"------------------------ PERMIT No.----- ------- ISSUED--- _S -S '----------------(Date) FINAL INSPECTION BY----------tzl ---------------------------------- - Date -� - �------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W 4 639